Summary
Summary NRNSG 1650 Midterm Study Guide
- Course
- NRSNG 1640
- Institution
- Concord University
This is a comprehensive and detailed study guide on midterm for NRNSG 1640. *Essential Study Material!!
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Study Guide for NR 1650Midterm HESI exam
1. Fluid and electrolytes- fluid volume deficit & fluid volume excess
A young adult male who has had type 2 diabetes mellitus (DM) is admitted to the intensive care
unit with hyperglycemic nonketotic syndrome (HHNS). A sliding scale protocol for an isotonic
IV solution with regular insulin is prescribed based on the results of a continuous blood glucose
monitoring device that is attached to the clients central venous catheter. When the clients
respirations become labored and his lungs sound indicate crackles what action should the nurse
take?
1. collect a specimen for a white blood cell count and cultures
2. determine the clients glycosylated hemoglobin (A1C)
3. administer insulin IV push until the clients fluid volume is adjusted
4. decrease infusion rate to address fluid overload
ANS: 4
A nurse in an emergency department is caring for a client who reports vomiting and diarrhea for
the past 3 days. Which of the following findings indicate to the nurse that the client is
experiencing fluid volume deficit?
Heart rate of 110/min
A nurse is assessing a client who has acute pancreatitis and has been receiving total parenteral
nutrition for the past 72 hours. Which of the following findings requires the nurse to intervene?
1. Right upper quadrant pain (patient has acute pancreatitis, so it’s normal)
2. Capillary blood glucose level of 164 mg/dl - glucose not significantly high
3. WBC counts 13,000/mm3 (Infection is one complication of TPN administration
4. Crackle in bilateral lower lobes (Priority, FVE/fluid shifts to the lungs may lead to
respiratory distress/collapse/failure) life threatening than infection. May need to decrease
ml/hr. and assess.
ANS: 4
Rationale: (chapter 47 page 299 MS ATI PDF 10.0) (ABC’s compromised, also one of the
complications of TPN is fluid imbalance aka fluid volume excess.)
A patient is admitted for hypovolemia associated with multiple draining wounds. Which
assessment would be the most accurate way for the nurse to evaluate fluid balance?
1. Skin turgor
, 2. Daily weight
3. Presence of edema
4. Hourly urine output
ANS: 2
A nurse assesses a client who has fluid volume excess. Which of the following manifestations
indicates fluid volume excess?
Jugular vein distension- The increase in venous pressure due to excessive circulating blood
volume results in neck vein distension.
Decreased hematocrit- The hematocrit measures packed cell volume of red blood cells expressed
as a percentage of total blood volume. With fluid volume excess, the hematocrit can decrease
because of excessive hemodilution.
Fever- Fluid volume excess or hypervolemia is an expansion of fluid volume in the extracellular
fluid compartment. This results in increased heart rate and bounding pulses.
2. Treatment of Hyperkalemia with a patient who misses dialysis
Leadership-CKD- misses dialysis- Lab
1. Chronic Kidney Failure: irreversible, slow deterioration of kidney function characterized
by increasing BUN and creatinine. Eventually dialysis is required.
2. If patient misses dialysis blood pressure will increase and fluid retention will worsen.
Toxicity from retention can travel within the blood stream.
3. Missed labs: increased potassium, increased sodium
4. Apples are good source of dietary nutrition
3. Dietary teaching for a patient with cholecystitis
A nurse is teaching a client with cholecystitis is about her diet after
discharge from the hosp teaching was effective when the client selects
which of the following foods?
Bananas
A nurse is assessing a client who has acute cholecystitis. Which of the following findings is the
nurse’s priority?
Tachycardia
, 4. Asthma- patient education for use of inhalers, longtime po steroid treatment ( cushings)
A nurse is teaching a client using a metered dose rescue inhaler. Which of the following
statements should the nurse include in the teaching?
a. Do not shake your inhaler before use C shake 5-6x.
b. Exhale fully before bringing the inhaler to your lips
c. Depress the canister after you inhale (depress the inhaler as the patient inhales to go in the
lungs).
d. Use peroxide to clean the mouthpiece if your inhaler (mild soap and water)
A nurse is reinforcing teaching with a client who has asthma. Which of the following client
statements indicate an understanding of the use of budesonide and albuterol inhalers? (Select all
that apply.)
1. a) "I should expect to feel sleepy after using my albuterol inhaler" (The client should
recognize that albuterol stimulates the sympathetic nervous system, which can cause
nervousness and insomnia, along with increased heart rate and blood pressure.)
2. b) "I never forget to rinse my mouth after using my budesonide inhaler. (The client
should rinse his mouth after using a budesonide inhaler to reduce the risk for oral fungal
infection.)
3. c) "Between office visits, I keep a record of how many times I use my albuterol
inhaler"(The client should record the number of times that he uses his albuterol inhaler.
This information can assist the provider to determine the effectiveness of the medication.)
4. d) "I use my albuterol inhaler before I go swimming" (The client should use the albuterol
inhaler before exercise to prevent exercise-induced bronchospasms.)
5. e) "I should use my budesonide inhaler before using my albuterol inhaler" (The client
should first use the albuterol inhaler, a bronchodilator, to open the airway and enhance
the absorption of the budesonide, which is an inhaled corticosteroid.)
Crushing Syndrome management:
1. TOO many glucocorticoids, mineralocorticoids, and sex hormones (steroids)
2. S/S: thin extremities, hyperglycemia, moon faced, buffalo hump, oily skin, high BP, CHF, weight
gain, fluid volume excess
3. Potassium levels is low watch for hypokalemia
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